by Robin Cook
After a quick breakfast of fruit and cereal, she got out of her apartment only fifteen minutes later than she would have liked. Mrs. Engler didn’t disappoint her. She cracked open her door on cue and looked out at Laurie with her bloodshot eyes as Laurie repeatedly hit the elevator button in the hope of speeding it up. Laurie smiled and waved at the woman but got no response other than Mrs. Engler clicking the door shut.
The walk up First Avenue was uneventful. It had turned colder than it had been the previous few days, but Laurie didn’t try to hail a cab. With her down coat zipped up to her neck, she was warm enough. She also enjoyed the distraction that the pulsating city provided. For her, New York had a dynamism like no other place on the planet, and her problems mercifully retreated into the recesses of her mind. In their place surfaced thoughts about the McGillan case and the hope that she would get slides from Maureen and a report from Peter. She also found herself wondering what kind of cases she’d get that day. She hoped they would be as absorbing and distracting as McGillan’s.
Laurie entered the OCME through the front door. In contrast with the previous morning, the reception area was empty. The administration area to the left was also empty. She waved to Marlene Wilson, the receptionist, who was enjoying the solitude and leafing through the morning paper. She waved back with one hand while buzzing Laurie into the ID room with the other. Laurie slipped out of her coat as she walked into the office.
Two of the more senior medical examiners, Kevin Southgate and Arnold Besserman, were sitting in the two brown vinyl club chairs, deep in conversation. Both waved to Laurie without interrupting their dialogue. Laurie waved back. She noticed that Vinnie Amendola was not in his usual spot, hiding behind his newspaper. She approached the desk where Riva was busy reviewing the cases that had come in overnight. Riva looked up, peering at Laurie over the tops of her glasses. Riva smiled. “Did you get more sleep last night?” she asked.
“Not a lot more,” Laurie confessed. “I was apartment cleaning until almost two.”
“I’ve been there,” Riva said with an understanding chuckle. “What happened at the hospital?”
Laurie told her about the visit and that her mother was doing fine. She talked briefly about her father but didn’t mention the BRCA1 problem.
“Jack is already down in the pit,” Riva said.
“I guessed as much when I noticed Vinnie wasn’t here reading the sports page.”
Riva shook her head. “Jack was already in here, rooting around in the cases, when I arrived before six-thirty. That’s too early for him to be in here. It’s pathetic. I told him to get a life.”
Laurie laughed. “That must have gone over well.”
“I also told him about your mom. I hope that was okay. He had asked where you had gone yesterday afternoon. Apparently, he’d come by our office just after you’d left for the hospital and I had gone down to talk with Calvin.”
“That’s fine,” Laurie said. “Now that I’ve been told, it’s no secret.”
“I hear you,” Riva said. “I can’t understand why your mother wouldn’t want to confide in you. Anyway, Jack was taken aback; I could tell.”
“Did he say anything in particular?”
“Not about your mom. He was quiet for a few minutes, which is not like Jack.”
“What kind of case is he doing?” Laurie asked.
“An ugly one,” Riva said. “He is amazing; I have to give him credit. The more difficult the case, whether emotionally or technically, the better he likes it. This one was particularly troubling from an emotional point of view. It was a four-month-old infant that had been abraded all over its little body, then brought into the ER, dead. The ER personnel were in an uproar of indignation, since the parents tried to say they had no idea what had happened. The police were called, and now the parents are in jail.”
“Oh, God!” Laurie voiced with a shudder. Despite thirteen years as a medical examiner, she still had trouble doing children, especially infants and abuse cases.
“I was in a muddle when I read the investigative report,” Riva admitted. “There was no question the child had to be posted, but there wasn’t anyone I disliked enough to assign it to.”
Laurie tried to laugh because she knew Riva was joking, but she only managed a smile. Riva liked everyone and vice versa. Laurie also knew that Riva would have taken the case herself, had Jack not volunteered.
“Before Jack went downstairs, he mentioned another case,” Riva said as she searched through the files before holding one up. “He said he’d had his usual informal tête-à-tête with Janice on his way in, and that she had told him there’d been a case of another young adult at the Manhattan General strikingly similar to McGillan’s. He said that you would probably want it, and that I should assign it to you. Are you interested?”
“Absolutely,” Laurie said. Her brows knitted as she took the folder. She opened it and rifled through the pages to find the investigative report. The patient’s name was Darlene Morgan, age thirty-six.
“She was the mother of an eight-year-old,” Riva said. “What a tragedy for the child.”
“My word,” Laurie voiced as she skimmed the report. “It does sound similar—strikingly similar.” She looked up. “Do you know if Janice is still here?”
“I haven’t the faintest idea. She was when I passed the PA’s office, but that was before six-thirty.”
“I think I’ll check,” Laurie said. “Thanks for the case.”
“My pleasure,” Riva said, but she was talking to Laurie’s back, because Laurie was already on her way.
Laurie moved quickly. Technically, Janice was off at seven, but she frequently stayed later. She was compulsive about her reports and often could be there as late as eight. It was seven-forty as Laurie passed through the clerical room. A minute later, she leaned into the investigator’s doorway. Bart Arnold looked up from his desk. He was on the phone.
“Is Janice still here?” Laurie asked.
Bart hooked his thumb over his shoulder to point into the depths of the room. Janice’s head popped out from around a monitor. She was sitting at the desk in the far corner.
Laurie walked in and grabbed a chair. She pulled it over to Janice’s desk and sat down. She waited until Janice finished a strenuous yawn.
“Sorry,” Janice said when she had recovered. She used a knuckle to wipe under her eyes; they were watering.
“You’re entitled,” Laurie said. “Was it a busy night?”
“Volume-wise it was the usual. Nothing like the night before, although there were a couple of heartbreakers. I don’t know what’s getting into me. I didn’t used to be so sensitive. I hope it’s not affecting my objectivity.”
“I heard about the infant.”
“Can you imagine? How can people be like that? It’s beyond me. Maybe I’m getting too soft for this job.”
“It’s when you stop being affected by such cases that you have to worry.”
“I suppose,” Janice with an exhausted sigh. She straightened herself up in her chair as if pulling herself together. “Anyway, what can I do for you?”
“I’ve just scanned your report on Darlene Morgan. The case strikes me as being disturbingly similar to that of Sean McGillan.”
“That’s exactly what I told Dr. Stapleton when I ran into him this morning.”
“Is there anything you can tell me that’s not in here?” Laurie said, waving the report in the air. “Like any impressions you might have gotten while talking to the people involved, like the nurses or the doctors or even the family members. You know, a step beyond the facts. Something that you sensed intuitively.”
Janice kept her brown eyes glued to Laurie’s while she thought. After a minute, she shook her head slightly. “Not really. I know what you mean, kind of a subliminal impression. But nothing came to mind. It was just another hospital tragedy. An apparently healthy, young-to-middle-aged woman whose time was up.” Janice shrugged. “When someone like that suddenly dies, it certainly makes yo
u realize we are all living on the edge.”
Laurie bit her lip while she struggled to think of what else she should ask. “You didn’t talk to the surgeon, did you?”
“No, I didn’t.”
“Was it the same surgeon who operated on McGillan?”
“No, there were two different orthopedic guys involved, and my impression from the resident was that both are held in high regard.”
“It seems that both patients died at about the same time in the morning. Did that seem strange to you?”
“Not really. In my experience, that two-to-four-A.M. time frame is quite popular for deaths to occur. It’s my busiest time during my shift. A doctor one time suggested to me it had something to do with circadian hormone levels.”
Laurie nodded. What Janice was saying was probably true.
“Dr. Stapleton told me that you did the post on Sean McGillan. Is the reason you are asking these questions because you didn’t find much pathology?”
“I found none,” Laurie admitted. “What about anesthesia? Any similarities there, like the same personnel or same agents?”
“I have to confess I didn’t look into that. Should I have?”
Laurie shrugged. “Both were about eighteen hours postsurgery, so they would still have remnants of the anesthesia on board. I think we’re going to have to look into everything, including all the medication they got and in what order and dosage. I asked Bart to get the McGillan chart. I’m going to need the Morgan chart also.”
“I can put in the request before I go,” Janice said.
Laurie stood up. “I appreciate it. I hope you don’t think my coming in here is a negative reflection on your investigative report, because it is quite the contrary. Your reports are always first-rate.”
Janice flushed. “Well, thank you. I try. I know how important it can be to have all the information, especially in mysterious cases like these four.”
“Four?” Laurie questioned with surprise. “What do you mean ‘four’?”
“As I recall, the week before last there were two others, both from the Manhattan General, that were similar from my end.”
“How similar? Were they patients who were in their first day postoperative, like McGillan and Morgan?”
“That’s my recollection. What I do remember for certain is that they were young and generally in good health, so that it was a big-time unpleasant surprise to everyone that they had cardiac arrests. I also remember both were found by the nurse’s aide while doing routine postoperative temperatures and heart rates, which is how Darlene Morgan was found, suggesting they had to have suffered some kind of major medical catastrophe. I mean, there was no warning. At least with Sean McGillan, he’d had a chance to ring his call button. Also, just like with McGillan and Morgan, the resuscitation team had zero luck. I mean, they got nothing but a flat line.”
“This could be very important,” Laurie said, pleased that she had come to seek out Janice.
“Anyway,” Janice said, “I was planning on pulling copies of the investigative reports, but I haven’t had time yet.”
“Were they orthopedic cases?”
“I don’t remember exactly what kind of surgery they had, but it will be easy to find out. If I had to guess, I’d say they were both general surgery cases, not orthopedic. Would you like me to pull the investigative reports?”
“Don’t bother. I’m certainly going to want to have the whole folders. Do you remember which doctor posted them?”
“I don’t think I ever knew. I don’t have much contact with the doctors, besides you and Dr. Stapleton.”
“Do you remember what was the final, official cause of death?” Laurie asked.
“Sorry,” Janice admitted. “I don’t even know if they have been signed out yet. Sometimes I follow up on cases that interest me, but not on the two we’re talking about. I have to admit that at the time, they seemed like a couple of pretty routine, unexpected major cardiac problems. I guess saying something is routine and unexpected is an oxymoron, so maybe routine is not the right word. I mean, people die in the hospital, as tragic as that may be, and a lot of times it’s not from the problem that brought them into the hospital in the first place. It wasn’t until this morning when I was writing up the Morgan case and thinking about the nurse’s aide angle that I even remembered them.”
“What were the names?” Laurie asked. She felt a shiver of excitement. This curious, unexpected yet potentially important snippet of information was exactly the reason she had wanted to talk with Janice. It made her feel more strongly that her medical-examiner colleagues who ignored the experience and expertise of the forensic investigators and the mortuary techs did so at their professional peril.
“Solomon Moskowitz and Antonio Nogueira. I wrote them down with their accession numbers.” Janice handed the paper to Laurie.
Laurie took the paper and looked at the names. Whether she was actively seeking a major diversion from her own personal problems she didn’t know. What she did know was that she had found one.
“Thanks, Janice,” Laurie said sincerely. “I’ve got to hand it to you. Associating these cases might be important.” One of the problems of there being eight medical examiners at the OCME is that such associations could slip through the cracks. There was a Thursday-afternoon conference where cases were vetted in an open forum, but it usually involved only the more academically interesting or even macabre ones.
“Don’t mention it,” Janice said. “It makes me feel good when I think I’m really part of the team and contributing.”
“You most certainly are,” Laurie responded. “Oh, and by the way, when you put in the request for Morgan’s chart, will you also ask for Moskowitz’s and Nogueira’s as well?”
“I’ll be happy to,” Janice said. She made a notation on a Post-it and put the reminder on the side of her monitor.
With her brain in a twitter, Laurie hustled out of the forensic investigator’s office and took the elevator up to the fifth floor. Concerns about BRCA1 and even Jack were pushed to the back of her mind. She couldn’t take her eyes off the two names on the paper that Janice had given her. Going from one curious case to four was a huge leap. The question was simply whether these four cases were indeed related. For her, this was what being a medical examiner was all about. If the cases were related by a common drug or procedure, and if she could figure it out, then she would have the rewarding opportunity to prevent more deaths. Of course, such information would also tell her if the deaths were accidental or homicidal, and that thought gave Laurie a shiver.
Entering her office, Laurie quickly hung up her coat behind the door, then sat down at the computer. She typed in the accession numbers of the two cases, learning that neither had been signed out as of yet. Mildly disappointed, she did get the names of the two doctors who had done the autopsies: George Fontworth had posted Antonio Nogueira, and Kevin Southgate had posted Solomon Moskowitz. Having seen Southgate down in the ID office earlier, she picked up her phone and dialed his extension. She let it ring five times before hanging up.
Returning to the elevator, Laurie descended to the first floor and wended her way back to the ID room. She’d hoped Kevin would still be there, talking with Arnold, and she wasn’t disappointed. She waited patiently for a break in their animated conversation. The two incessantly argued about politics: Kevin, the inveterate liberal Democrat, and Arnold, the equivalent conservative Republican. Both had been at the OCME for almost twenty years and had come to resemble each other. Both were overweight with ashen complexions and were haphazard about their hygiene and dress. In Laurie’s mind, they were the stereotypical coroners in old Hollywood movies.
“Do you remember posting a Solomon Moskowitz about two weeks ago?” Laurie asked Kevin after apologizing for interrupting. As usual, he and Arnold seemed to be just shy of exchanging blows. They frustrated each other, since neither had a snowball’s chance in hell of changing the other’s entrenched opinions.
After joking that he couldn
’t remember the cases he did yesterday, Kevin’s doughy face screwed up in thought. “You know, I think I remember a Moskowitz,” he said. “Do you happen to know if it was a Manhattan General case?”
“That’s what I was told.”
“Then I remember it. The patient had an apparent cardiac arrest. If it’s the one I’m thinking about, there wasn’t much on the post. I don’t believe I’ve signed it out yet. I imagine I’m waiting for the microscopic to come back.”
Yeah, sure, Laurie thought to herself. Even in the busiest of times, it didn’t take two weeks to get slides. But she wasn’t surprised. Kevin and Arnold were notorious for failing to get their cases out on a timely basis. “Do you remember if the patient had had recent surgery?”
“Now you’re pushing your luck. I tell you what, why don’t you stop up to my office, and I’ll let you go over the folder.”
“Sounds like a good idea,” Laurie responded. She was momentarily distracted by seeing George come in through the door to the ID room, removing his coat. Allowing Kevin and Arnold to get back to their bickering, Laurie joined George at the coffee machine.
George had been at the OCME for almost as long as Kevin and Arnold, but he hadn’t picked up any of their personal habits. He appeared significantly more stylish, with pressed pants, a clean shirt, and a colorful tie, all of which were reasonably contemporary, which was how he liked to present himself. He also looked dramatically younger by avoiding the common middle-age weight gain. Although Laurie knew Jack did not hold George in high esteem professionally, she had always found him easy to work with.
“I heard your gunshot case yesterday had a surprising denouement,” Laurie said.
“What an ordeal,” George complained. “If Bingham ever offers to do another case with me, remind me to graciously refuse.”